I have been treating patients in South India, NorthIndia, Iran, Ohio and Texas for>35 years total.
What I see is stupid scaremongering by some Ivory tower doctors and the corrupt as well as stupid FDA which is leading to poor treatment of severe anxiety in some patients who are going from doctor to doctor and in the process getting the label " Drug seeking".
Recently an 81-year-old woman came to me asking to get rid of her addiction to 0.25 mg alprazolam per day! Why now after 20 + years of use? she said she was told by a newly minted doctor that it is an addictive medication and she does not want to be a "Junkie"
A number of Agoraphobic patients who can not afford to go see specialist Psychiatrists are denied proper treatment or prescribed new drugs( exorbitantly costly but really useless clinically)
Serious and fatal adverse events associated with diazepam are extremely rare and are most often a consequence of interaction with another drug (such as opiates or alcohol). The most common fatal events are respiratory arrest and prolonged seizures resulting from prolonged habitual use, rather than acute overdose. In fact, reported cases of overdoses up to 2000 mg diazepam have resulted in an induced temporary coma with speedy recovery. More moderate adverse effects from chronic diazepam use include amnesia, dizziness, ataxia, confusion, sedation, depression, and tachycardia. Also, worsening of seizures or anxiety can occur in some patients being treated for epilepsy or anxiety disorders.48
Diazepam exhibits a lower risk profile for addiction and dependence than other benzodiazepines, and it is typically used for treatment of withdrawal symptoms from other benzodiazepines and alcohol.
What I see is stupid scaremongering by some Ivory tower doctors and the corrupt as well as stupid FDA which is leading to poor treatment of severe anxiety in some patients who are going from doctor to doctor and in the process getting the label " Drug seeking".
Recently an 81-year-old woman came to me asking to get rid of her addiction to 0.25 mg alprazolam per day! Why now after 20 + years of use? she said she was told by a newly minted doctor that it is an addictive medication and she does not want to be a "Junkie"
A number of Agoraphobic patients who can not afford to go see specialist Psychiatrists are denied proper treatment or prescribed new drugs( exorbitantly costly but really useless clinically)
Diazepam is approved for the treatment of anxiety, acute alcohol withdrawal, skeletal muscle spasm, and convulsive disorders (e.g., status epilepticus).3 It is used off-label for numerous other conditions including insomnia, restless leg syndrome, and pre/post-operative sedation. It is a Schedule IV controlled substance.2Approved Indications
Diazepam exhibits a lower risk profile for addiction and dependence than other benzodiazepines, and it is typically used for treatment of withdrawal symptoms from other benzodiazepines and alcohol.
Despite the vast majority of prescriptions validated for legitimate medical use, and abuse mostly occurring in individuals abusing other illicit drugs (especially heroin and alcohol), diazepam and other benzodiazepines fell out of favor with much of the medical community and were stigmatized by public regulatory institutions. While the restrictions in the United States, under the Controlled Substances Act as a schedule IV drug, have been relatively soft, action taken in European countries and in certain domestic areas has been more severe.57 Trialozam 16, one of the most frequently prescribed benzodiazepines in the United States and the United Kingdom, was suspended and then removed from the market in The Netherlands in 1979, the United Kingdom in 1991, and other western European nations quickly followed suit.58 Several countries placed hard restrictions on other benzodiazepines with high potentials for abuse (especially through intravenous routes), such as temazepam 11.59 The state of New York passed rigorous compliance regulations in 1989, most notably the requirement of state-issued triplicate copy prescription forms. This resulted in a 30–60% decrease in benzodiazepine prescriptions, and large increases in the use of inappropriate therapeutics (such as chloral hydrate and meprobamate) at rates over 100%.60 In 1994, the World Health Organization expert committee on drug dependence considered flunitrazepam (13) abuse as a substantial threat to public health.61 On top of self-abuse, flunitrazepam is used as a “date rape” drug, and therefore has historically received tighter regulations and scheduling than other benzodiazepines.48a While single actions against diazepam have not been taken, it certainly assumes the role as the face of general benzodiazepine class regulations, especially as Valium, “Mother’s Little Helper”. With the arrival of new tricyclic and SSRI compounds, in addition to the lingering backlash and fears from overuse in the 1970s and 1980s, diazepam prescriptions fell dramatically.62
However, there have been recent calls to dispel the “end of the benzodiazepine era”. While treatment for OCD has yielded to newer classes of drugs, benzodiazepines are still considered first-line treatment for most other anxiety disorders and phobias. This is partly due to major side effects in SSRIs, lackluster efficacy versus specific conditions, and slower onset of action, despite many groups still championing SSRIs as first-line treatment.63
The future of diazepam is still unfolding, but its addition to the World Health Organization’s list of essential medicines highlights its crucial role to modern medicine. Diazepam’s 50-year history of raising the standard of care and revolutionizing treatments in anxiety and epilepsy, among other illnesses, unequivocally earns the status as a classic in chemical neuroscience
*
No comments:
Post a Comment